Highlights
- •The practice of effective preventive medicine relies on adequate risk stratification.
- •SF-36®, a simple questionnaire completed by patients, outperforms biomarkers in predicting mortality in a primary cardiac prevention clinic in this exploratory study.
- •Additional data are needed to further define which specific patients might benefit from a questionnaire-based approach for risk stratification.
Abstract
Background
Risk stratification plays an important role in evaluating patients with no known cardiovascular
disease (CVD). Few studies have investigated health-related quality of life questionnaires
such as the Medical Outcomes Study Short Form-36 (SF-36®) as predictive tools for mortality, particularly in direct comparison with biomarkers.
Our objective is to measure the relative effectiveness of SF-36® scores in predicting mortality when compared to traditional and novel biomarkers
in a primary prevention population.
Methods
7056 patients evaluated for primary cardiac prevention between January 1996 and April
2011 were included in this study. Patient characteristics included medical history,
SF-36® questionnaire and a laboratory panel (total cholesterol, triglycerides, HDL, LDL,
ApoA, ApoB, ApoA1/ApoB ratio, homocysteine, lipoprotein (a), fibrinogen, hsCRP, uric
acid and urine ACR). The primary outcome was all-cause mortality.
Results
A low SF-36® physical score independently predicted a 6-fold increase in death at
8 years (above vs. below median Hazard Ratio [95% confidence interval] 5.99 [3.86–9.35],
p < 0.001). In a univariate analysis, SF-36® physical score had a c-index of 0.75, which
was superior to that of all the biomarkers. It also carried incremental predictive
ability when added to non-laboratory risk factors (Net Reclassification Index = 59.9%), as well as Framingham risk score components (Net Reclassification Index = 61.1%). Biomarkers added no incremental predictive value to a non-laboratory risk
factor model when combined to SF-36 physical score.
Conclusion
The SF-36® physical score is a reliable predictor of mortality in patients without
CVD, and outperformed most studied traditional and novel biomarkers. In an era of
rising healthcare costs, the SF-36® questionnaire could be used as an adjunct simple
and cost-effective predictor of mortality to current predictors.
Keywords
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Article info
Publication history
Published online: June 15, 2017
Accepted:
May 25,
2017
Received in revised form:
May 19,
2017
Received:
September 21,
2016
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
